Therapy isn’t always the answer

Following on from my post about helping your depressed friends, I think it might be helpful to talk about therapy. Encouraging your depressed and anxious friends to get therapy or counselling may seem like a kind and helpful thing to do, but it isn’t. Trust me, they’ve already thought about it, and if they aren’t heading that way, there are reasons.

Free therapy and counselling are hard to come by and tend to take many months, if not years to access. That’s no use to a person who is in crisis right now. Chasing support that won’t manifest for ages may not strike them as a good use of their time and energy when they are already in trouble.

Counselling and therapy can be accessed much faster if you can pay for it. However, many of us don’t have a spare £50 a week to spend on an hour of professional support. To be effective, you need to spend a lot of time and money, and for many people that just isn’t possible. Therapy is a long term solution not the answer to an immediate crisis. There are almost no resources available to deal with immediate mental health crisis.

Most trauma therapy resources start from the assumption that you’ve had one bad experience and need to reboot. This is as true of online free resources as it is therapists. If you have experienced complex trauma, this whole approach can be unhelpful through to harmful. If your trauma was in childhood, you may have no normal to go back to. Complex trauma is complicated and specialists are few and far between.

Distress can be complicated by many factors – poverty being one of them. Not everyone will admit to you that they can’t afford a therapist. Depression and anxiety often have their roots in real and intractable problems that a therapist can’t deal with. Yes, tools to help you handle it better might be nice, but they aren’t worth much when you’re dealing with abuse, workplace bullying, insecure accommodation, systemic racism, gender identity crises etc. Sometimes you just have to deal with or live with the problems and a therapist might not actually be able to help with that. And sometimes they can, but that’s a really personal decision about whether you think you have the kinds of problems that can be helped with in this way.

The more complicated your issues, the harder it will be to find someone who knows how to help you. Your expert on supporting people with domestic abuse may know nothing at all about polyamoury. They may even have a really unkind attitude to that – as happened to me once. The expert on grief processing might not know anything much about how to help someone with an eating disorder and the two might be deeply intertwined for you. The person with great skills for tackling irrational anxiety might not have any idea how that intersects with your experience of racial abuse. And so it goes on.

How many therapists you could potentially access depends on where you live and what access to transport you have and how much time and money you can afford to spend travelling to people. Or it depends on your intent access, which might not be good enough or may not allow you the privacy for online conversations. A lot of free support has religious underpinnings. Pagans may not feel comfortable going to Christian counsellors, who may be entirely unable to help them. Even if therapy is a good idea, there are lots of reasons why it might not be available.

One thing I would particularly ask is not to tell people that healing is dependant on getting professional support. Healing is easier, often with the right support, but there are few things more depressing than being told your poverty or complexity means there’s no way out for you. Many of us have to heal without a professional guide in the mix. Books exist. Peer support exists. Working it out from scratch exist. Please don’t invalidate these solutions because for many people they are the only options available. And it is possible. I’ve unpicked and got under control a number of PTSD triggers over the years. It was bloody hard work, and I expect it’s easier with good support, but it is possible

Helping your depressed friend

Most days I see someone on social media encouraging their depressed friends to ask for help. Would that it were that simple! There are reasons depressed people don’t seek help that have everything to do with the nature of depression. Depressed people don’t generally ask for help.

Asking for help can lead to pressures to do the things the other person wants you to do. It can result in being told to take up yoga, pay for therapy, get on anti-depressants right now… as though you’ve never considered doing anything that might help. If the depressed person’s reasons for not doing something are ignored, or rubbished, that’s not helpful. If pressure is applied to seem happier so that the person you asked for help can feel validated and helpful… you don’t ask for help. Go a few rounds with such responses and you stop risking being put through all of that.

Depression can make it hard to think, and hard to make choices. Rather than telling your depressed friend to ask for help, try offering them specific forms of help and then helping on the terms they would find helpful.

Offer to listen. Be very clear whether your friend needs someone to hear them or if they actually want advice. If you have first hand experience of depression  you may well have useful insights, but if you’ve not been through it yourself it is better to assume that you don’t know anything useful about how to deal with the depression itself. Unsolicited advice based on assumptions is the opposite of helpful.

Look for the practical things. Does your depressed friend need a hand with the housework? Could you pick up some shopping for them or cook them a meal? Depression can make it very hard to do the things that would take care of yourself. Stepping in to do simple, practical things can make a lot of difference. You don’t need to do emotional heavy lifting to help someone who is depressed. Helping them overcome the problems depression causes can be worth a lot more.

Can you do something to lift their spirits? Can you do it while being ok with however they seem? If you can take someone out for the day or do something nice for them without needing that to instantly magically fix them, then get in there. Don’t offer if you’re going to get cross when your one intervention doesn’t instantly fix everything. 

Often what seems to happen is that well people offering help mostly want to make themselves feel more comfortable. This may sound harsh, but I’ve seen it too many times. The people who get angry when you explain why their magic solution wouldn’t work for you. The people who get angry when you don’t want to go on antidepressants, or take whatever wonder-substance they think you should take… this is not about making the depressed person better. It is about the comfort of the person who wants to be seen as a saviour.

If you’re offering anyone help, think long and hard about what kind of help you can really offer and how you think that will play out. If it’s all about you, centre stage as the marvellous hero, then you might do your depressed friend more good by just leaving them be.